She appears frustrated after questioning
as evidenced by her facial expression and body language.

Client’s daughter, who is staying with her, reports that her mother doesn’t seem
to be “herself” since the stroke, and that she sometimes had mood swings and periods
of confusion.

On the morning of her admission, her daughter stated that she was cooking breakfast
when she collapsed onto the floor. She had complained for the past 2 days of a headache
with visual changes, difficulty speaking, and progressive right-sided weakness

Objective

Client is alert and oriented at present, but has a difficult time speaking, client
has paralysis on her right side with decreased grips and reflexes on the left side.

difficulties in expressing her needs and thoughts, which caused her much frustration

Problem

Impaired Verbal Communication

Long Term:

Client willuse effective communication
techniques by the time of discharge and continue using effective communication techniques
through rehab and speech therapy.

Involve a familiar person when attempting to communicate with a client who has difficulty
with communication, if accepted by the client. EB:
Conversation partners of individuals with aphasia, including healthcare professionals,
families, and others, play a role that is important for communication for individuals
with aphasia (Roth, 2004).

Listen carefully. Validate verbal and nonverbal expressions particularly when dealing
with pain. EBN: Listening to a client was identified
as a caring behavior of nurses (Gregg, 2004). EBN: Nonverbal indicators of
pain observed by nurses of clients with intellectual disabilities: moaning, crying,
painful facial expression, swelling and screaming during manipulation, not using
(affected) body part, and moving the body in a specific way of behaving (Zwakhalen et al, 2004).

Using an individualized approach, establish an alternative method of communication
such as writing or pointing to letters, word phrases, picture cards, or simple drawings
of basic needs. EB: Alternative methods of communication
are necessary when the client is unable to speak verbally (Happ, Roesch & Kagan, 2005).

Teach the client and family techniques to increase communication, including the
use of communication devices. Alternative methods
of communication are necessary when the client is unable to use verbal communication.

Client will demonstrate understanding
of daily treatment even if not able to speak
by end of shift on 1300 on [date].

Use presence. Spend time with the client, allow time for responses, and make the
call light readily available. EBN: Attentive presence
makes explicit that the other is cherished; it is a universal lived experience that
is important to health and quality of life (Carroll, 2002). EBN: Time with the nurse had
a positive effect on the healing process and recovery (Rudolfsson et al, 2003).

Explain all healthcare procedures. EBN: Clients
who were nonvocal and ventilated were attuned to everything occurring around them,
and they appreciated explanations from the nurse (Carroll, 2004).

Teach the client and family techniques to increase communication, including the
use of communication devices. Alternative methods
of communication are necessary when the client is unable to use verbal communication.

AEB

Her facial expression and body language and difficult time speaking

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*I = Implementation.Check those interventions/actions/orders
that were implemented.

Roth EJ: Grand rounds. A set of observational measures
for rating support and participation in conversation between adults with aphasia
and their conversation partners, Top Stroke Rehabil 11(1):6783, 2004.